PC014. Intercostal Coil Embolization to Induce False Lumen Thrombosis in Chronic Type B Aortic Dissection

We herein describe a 38-year-old woman with Marfan syndrome and chronic type A aortic dissection. Computed tomography showed that the sinus of Valsalva and thoracoabdominal aorta had a diameter of 62 and 55 mm, respectively. After 7 months of a Bentall operation and total arch replacement with the elephant trunk technique, we performed thoracic endovascular aortic repair for an aneurysm of the descending aorta, but we preserved the retrograde flow into the false lumen because it supplied vessels perfusing the spinal cord. Computed tomography angiography 14 months after thoracic endovascular aortic repair showed that the thoracic aortic diameter had increased to 68 mm. We then performed partial (proximal only) coil embolization of the false lumen. After 6 months, the thoracic aortic diameter had decreased to 60 mm and the spinal cord remained perfused via the distal false lumen. Staged coil embolization after thoracic endovascular aortic repair for aneurysmal chronic type B aortic dissection is feasible and can be beneficial.

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Management of Residual False Lumen Flow After Thoracic Endovascular Repair in Chronic Type B Aortic Dissection

Cardiology and Cardiovascular Medicine ◽

10.26502/fccm.92920155 ◽

2020 ◽

Vol 04 (05) ◽

Author(s):

Hervé Rousseau ◽

Paul Revel-Mouroz ◽

Charline Zadro ◽

Camille Dambrin ◽

Christophe Cron ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Repair ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Thoracic Endovascular Repair

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Safety and Effectiveness of TEVAR in Native Proximal Landing Zone 2 for Chronic Type B Aortic Dissection in Patients With Genetic Aortic Syndrome

Journal of Endovascular Therapy ◽

10.1177/15266028211061276 ◽

2021 ◽

pp. 152660282110612

Author(s):

Ahmed Eleshra ◽

Giuseppe Panuccio ◽

Konstantinos Spanos ◽

Fiona Rohlffs ◽

Yskert von Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Ehlers Danlos Syndrome ◽

Landing Zone ◽

Aortic Repair

Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in a native proximal landing zone (PLZ) 2 for chronic type B aortic dissection (TBAD) patients with genetic aortic syndrome (GAS). Methods A retrospective review of a single center database to identify patients with GAS treated with TEVAR in native PLZ 2 for chronic TBAD and thoracic false lumen aneurysm between February 2012 and February 2018 was undertaken. Results In total, 31 patients with GAS (24 Marfan syndrome [MFS], 5 Loeys-Dietz syndrome [LDS], and 2 vascular Ehlers-Danlos syndrome [vEDS]) were treated by endovascular repair. Nineteen patients were treated by TEVAR as index procedures with 8 patients (5 females, mean age = 55, range = 36–79 years old) receiving TEVAR in native PLZ 2. Left subclavian artery (LSA) perfusion was preserved in all 8 patients: by left common carotid artery-LSA bypass in 6 patients, chimney stenting of the LSA in 1 patient, and partial coverage of LSA ostium in 1 patient. Technical success was achieved in all patients (100%). There was no 30 day mortality (0%). The 30 day morbidity (0%) was free from major complications. The median follow-up was 40 months (range = 7–79). One patient died due to non-aortic-related cause. Native PLZ 2 was free from complications in MFS patients (5/8). Two patients with LDS developed type Ia endoleak with aneurysmal progression. One patient was treated by proximal extension with a double inner branched arch stent-graft landing in the replaced ascending aorta. The other one was treated with frozen elephant trunk. Conclusion Thoracic endovascular aortic repair in native PLZ 2 was safe and effective with no early or midterm PLZ complications in patients with MFS with chronic TBAD in this limited series. Native PLZ 2 is not safe in patients with LDS and should only be used in emergencies as a bridging to open repair.

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Flow Diversion: A Novel Technique In The Management Of Aneurysmal False Lumen In Chronic Type B Aortic Dissection

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.01.036 ◽

2020 ◽

Vol 63 ◽

pp. 10-11

Author(s):

Motahar Hosseini ◽

David N. Blitzer ◽

Anahita Ghazi ◽

Shahab Toursavadkohi

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Flow Diversion ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Novel Technique

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Thoracic endovascular repair for disseminated intravascular coagulation associated with chronic type B aortic dissection

Vascular ◽

10.1177/1708538120934575 ◽

2020 ◽

Vol 28 (6) ◽

pp. 705-707

Author(s):

Jumpei Yamamoto ◽

Arudo Hiraoka ◽

Hidenori Yoshitaka

Keyword(s):

Aortic Dissection ◽

Disseminated Intravascular Coagulation ◽

Endovascular Repair ◽

Rare Complication ◽

False Lumen ◽

Celiac Artery ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Intravascular Coagulation

Objectives Chronic disseminated intravascular coagulation is a rare complication of aortic dissection, and its optimal treatment remains controversial. Methods We present a 78-year-old man with repeated hemorrhagic events by disseminated intravascular coagulation due to chronic aortic dissection treated by thoracic endovascular aortic repair. Results Computed tomography angiography at three months revealed a completely thrombosed false lumen from the distal aortic arch to the descending aorta at the celiac artery level. Platelets and D-dimer levels remained stable, and the patient was doing well without hemorrhagic complications. Conclusions Endovascular repair was effective for disseminated intravascular coagulation due to chronic type B aortic dissection.

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Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.11.059 ◽

2008 ◽

Vol 47 (4) ◽

pp. 844-851 ◽

Cited By ~ 114

Author(s):

Thomas T. Tsai ◽

Marty S. Schlicht ◽

Khalil Khanafer ◽

Joseph L. Bull ◽

Doug T. Valassis ◽

...

Keyword(s):

Aortic Dissection ◽

Ex Vivo ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Ex Vivo Model ◽

Tear Size

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Coil Embolization of the False Lumen in Complicated Type B Aortic Dissection

Annals of Vascular Surgery ◽

10.1016/j.avsg.2014.07.041 ◽

2015 ◽

Vol 29 (1) ◽

pp. 125.e13-125.e17 ◽

Cited By ~ 10

Author(s):

Mohamad A. Hussain ◽

Thomas F. Lindsay ◽

Kong T. Tan ◽

Tony Moloney

Keyword(s):

Aortic Dissection ◽

Coil Embolization ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection

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Transfemoral Transcatheter Aortic Valve Implantation using a Long Sheath for Chronic Type B Aortic Dissection: A Case Report

10.22541/au.162281700.05784640/v1 ◽

2021 ◽

Author(s):

Masaki Tsuda ◽

Yasuyuki Egami ◽

Koji Yasumoto ◽

Naotaka Okamoto ◽

Yasuharu Matsunaga-Lee ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Transcatheter Aortic Valve Implantation ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

A 79-year-old woman with a history of open heart surgery presented with severe aortic stenosis (AS). Computed tomography (CT) showed chronic type B aortic dissection (TBAD) between the distal aortic arch and the left common iliac artery. After careful consideration, we planned transfemoral (TF)-transcatheter aortic valve implantation (TAVI) using a 20-Fr long sheath to minimize contact with the false lumen of the aorta. TAVI was performed under general anesthesia, guided by transesophageal echocardiography (TEE). A transcatheter aortic valve was successfully implanted. TEE, immediately after valve implantation, showed no remarkable changes in the descending thoracic aorta. Repeated post-procedural CT examinations showed no obvious changes in the aorta. The patient was stable without sequelae at the 12-month follow-up. This case demonstrates that TF-TAVI using a long sheath under TEE guidance can be a treatment option for patients with severe AS and chronic TBAD.

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